Enlarged hilar periportal space sign

Last revised by Dr Fabio Macori on 23 Jun 2022

The enlarged hilar periportal space sign refers to the widening of the periportal space seen on MRI in early liver cirrhosis.

Enlarged hilar periportal space sign is one of the early signs of cirrhosis and may be used to detect fibrotic changes in the liver in patients who do not yet have typical signs of cirrhosis as usually seen in advanced disease. Detection of early cirrhosis has treatment implications as interferon therapy has been found to be beneficial in early cirrhosis associated with chronic viral hepatitis.

On MRI, the right portal vein is seen to lie between the anterior margin of the caudate lobe and the posterior margin of the medial segment of the left lobe. Normally, the space anterior to the right portal vein is narrow and contains minimal fatty tissue. In patients with early cirrhosis, this space has been found to be widened due to atrophy of the medial segment and increased fat anterior to the right main portal vein.

The thickness of the hilar periportal space is measured on the plane where the right portal vein is seen on the axial plane. The distance between the anterior wall of the right portal vein and the posterior margin of the medial segment of the left hepatic lobe, with the line of distance perpendicular to the long axis of the right portal vein.

The normal periportal space measures 0-11 mm while in early cirrhosis, the periportal space measures 9-40 mm 2. A cut-off value of 10 mm for the anterior hilar periportal space has a sensitivity of 93% and specificity of 92% for a diagnosis of early cirrhosis on MRI 2.

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